Chest pain, almost everyone has experienced this symptom, it is too common. However, the causes behind it are varied and unclear, and the treatment is often “wrong”. Heart disease can lead to heart pain, but so can pneumonia, pleurisy, esophagitis, etc. So, how do we set aside the clouds and see the true nature of Mount Lushan?
What are the most common causes of chest pain?
There are many causes of chest pain, which can be caused by thoracic diseases and can also originate from organ lesions in the thoracic cavity. In addition, lesions of tissues and organs outside the thorax, such as abdominal lesions, and even psychosomatic diseases such as anxiety disorders, can also cause chest pain.
However, what is the most common cause of chest pain? The answer is musculoskeletal diseases, that is, it is not the organs inside the chest that have problems, but only the muscles and bones on the surface of the chest that are “sick”, such as thoracic costochondritis, fasciitis, intercostal neuritis, and rib fractures.
There is evidence for this. There are several foreign literature sources that illustrate this point. Medical doctors in the United Kingdom and the United States spent a year counting patients with chest pain who were seen in general practice clinics, all of whom were 50 years of age or older. It turned out that the most common disease for chest pain was musculoskeletal disorders, accounting for 36%. The proportion of other diseases was much lower, with heart disease accounting for 16%, gastrointestinal diseases for 8%, respiratory diseases for 5%, and psychological diseases such as anxiety and depression for 16%.
What are the most serious causes?
Although the most common cause of chest pain is musculoskeletal “disease”, do not rest on your laurels! Among other things, some chest pains can be fatal, and a little carelessness can cause heart and breathing to stop, costing you your life. There is an article called “Chinese Expert Consensus on Standardized Evaluation and Diagnosis of Chest Pain”, which divides chest pain into two categories according to the degree of criticality: fatal chest pain and non-fatal chest pain.
What are the fatal chest pains?
① Heart attack
The familiar myocardial infarction and angina pectoris are the top-ranked fatal chest pain diseases. If severe pain occurs in the left chest and radiates to the left shoulder, and cannot be relieved by nitroglycerin in the mouth, it may be myocardial infarction and acute coronary syndrome. Immediate treatment is needed. Please call 120 or send to the emergency department of the annex hospital immediately.
②Aortic coarctation
If a patient with high blood pressure, especially those with poorly controlled blood pressure, suddenly has severe chest pain like cutting or tearing, pale face and sweating profusely, it may be “aortic coarctation”.
Aortic coarctation is caused by the tearing of the intima of the aorta and the entry of blood into the vessel wall, resulting in aortic dissection or rupture. If not rescued in time, life is at stake.
③Pulmonary embolism
If a person with varicose veins in lower limbs and sedentary (such as long-distance bus or airplane) suddenly has chest pain, dyspnea and hemoptysis (the professional term is “pulmonary embolism triad”), or even fainting, loss of consciousness and blue lips, it may be the legendary “pulmonary embolism It may be the legendary “pulmonary embolism”. This disease is also extremely dangerous.
④Tension pneumothorax
If a tall young man who smokes, is thin and long, coughs or exercises strenuously, or even has strenuous defecation and then has pinprick-like or knife-like chest pain, followed by chest tightness and difficulty in breathing, it may be a “spontaneous pneumothorax” attack.
If you encounter these urgent and fatal chest pains, make sure to call 120 ambulance immediately or send to the emergency department of a nearby hospital.
What other diseases can cause chest pain?
①Respiratory system diseases
Such as pneumonia, bronchitis, etc., cause chest pain, mostly accompanied by coughing, coughing and fever, and often the chest pain worsens with coughing and deep breathing.
②Reflux esophagitis
Often a burning sensation behind the sternum, aggravated by lying down and relieved by sitting up; acid reflux, nocturnal reflux, often with coughing.
③Herpes zoster
Chest pain manifests as a burning neuralgia, the most important feature is that the pain is felt first, and after a few days clustered blisters appear, which are distributed in a band along a unilateral nerve.
There are also some people who have chest pain even when they are not physically ill. We often see such patients in our clinic: they are troubled by chest pain for a long time and repeatedly visit cardiology, respiratory medicine, thoracic surgery, gastroenterology and other departments, asking for a comprehensive examination. After all the tests and examinations are done, everything turns out to be normal and no disease is found.
Why is this? The answer is that there is a psychological problem. From the analysis of “physiological-psychological-social” medical model, this kind of chest pain patients do not have organic diseases, that is to say, they do not have physiological diseases, but they have psychological diseases, which often manifest as anxiety, depression, insomnia, dreaming, fatigue and weakness. These patients often describe their chest pain symptoms to the doctor in this way: vague, stabbing pain, irregular location of pain, and variable duration. They may also sigh unconsciously or take deep breaths.
How do you distinguish between anxiety/depression-induced chest and back discomfort and angina pectoris?
Angina lasts for a few minutes, while chest discomfort due to anxiety/depression is either too short (a few seconds or one or two beats) or too long, up to several hours to several days. Angina often occurs during exercise, while chest pain due to anxiety/depression often does not occur with exercise or instead decreases and disappears.
Anxiety/depression is often accompanied by other symptoms, such as impatience or depression, and loss of interest in things that used to be of interest. Fear of being in small, enclosed spaces, such as elevators. Fear of flying. Sleep disturbances, including difficulty falling asleep or waking up early. Feeling that you don’t have enough breath and like to take long breaths.
Patients with coronary artery disease can have both angina pectoris and chest discomfort due to anxiety/depression, which should be distinguished, served by double heart and treated comprehensively; some patients with anxiety/depression can have somatic discomfort mainly in the chest, some mainly in the abdomen, and some in both areas; some people with no cardiovascular disease at all can have chest and back discomfort due to anxiety/depression and be seen in cardiology for years.
In short, cure occasionally, go to help often, and always go to comfort.